Bifurcated prosthetic graft

ABSTRACT

A prosthetic graft for use with a graft system is used to repair the treatment of aortic aneurysms which extend into at least one common iliac artery and do not have a suitable region for seating a stent or other attachment device. The graft is designed to be used in combination with a graft system having legs extending into the common iliac arteries and provides the graft system with a place to securely seat its iliac legs without blocking the internal iliac artery.

FIELD OF THE INVENTION

[0001] This invention relates to a bifurcated prosthetic graft and amethod for deploying the graft at an area of vessel bifurcation. Theinvention is a bifurcated prosthetic graft for deployment at thebifurcation of the common iliac artery, and in particular, for use witha biluminal graft system for use in repairing abdominal aorticaneurysms.

BACKGROUND OF THE INVENTION

[0002] Aortic aneurysms represent a significant medical problem for thegeneral population. Aneurysms within the aorta presently affect betweentwo and seven percent of the general population and the rate ofincidence appears to be increasing. This form of vascular disease ischaracterized by a degradation in the arterial wall in which the wallweakens and balloons outward by thinning. If untreated, the aneurysm canrupture resulting in death within a short time.

[0003] The traditional treatment for patients with an abdominal aorticaneurysm is surgical repair. This is an extensive operation involvingtransperitoneal or retroperitoneal dissection of the aorta andreplacement of the aneurysm with an artificial artery known as aprosthetic graft. This procedure requires exposure of the aorta throughan abdominal incision extending from the lower border from the breastbone down to the pubic bone. The aorta is clamped both above and belowthe aneurysm so that the aneurysm can be opened and the prosthetic graftof approximately the same size as the aorta can be sutured in place.Blood flow is then re-established through the prosthetic graft. Theoperation requires a general anesthesia with a breathing tube, extensiveintensive care unit monitoring in the immediate post-operative periodalong with blood transfusions and stomach and bladder tubes. All of thisimposes stress on the cardiovascular system. This is a high-risksurgical procedure with well-recognized morbidity and mortality.

[0004] More recently, significantly less invasive clinical approaches toaneurysm repair known as endovascular grafting have been proposed. (See,Parodi, J. C., et al. “Transfemoral Intraluminal Graft Implantation forAbdominal Aortic Aneurysms,” 5 Annals of Vascular Surgery, 491 (1991)).Endovascular grafting involves the transluminal placement of aprosthetic arterial graft in the endoluminal position (within the lumenof the artery). By this method, the graft is attached to the internalsurface of an arterial wall by means of attachment devices such asexpandable stents, one above the aneurysm and a second below theaneurysm.

[0005] It is not uncommon for abdominal aortic aneurysms to extend tothe aortic bifurcation or even into the common iliac arteries. When theaneurysm extends into the common iliac arteries it is necessary that thegraft system used to repair the aneurysm extend into the common iliacarteries past the aneurysm. This requires that there be enough spacebetween the aneurysm and the common iliac bifurcation so that the graftcan properly seat. By “seating” it is meant that the graft is somehowfixed to the non-aneurysmal vasculature. However, in a significantnumber of patients the aneurysm extends into the common iliac arterieson one or both sides such that there is not enough room to seat thegraft without at least partially blocking the internal iliac artery.Such a situation occurs in so-called Class D or E aneurysms. Theinternal iliac artery is a significant vessel which supplies blood tothe pelvic region. Blockage of the vessel can result in undesirableconsequences for the patient. For this reason, patients in this categoryare often excluded from the less expensive and less traumaticendovascular repair and must instead undergo the invasive surgicalprocedure described above.

[0006] Therefore, a need exists for an improved prosthetic graft whichwill allow endoluminal reconstruction of the common, external, andinternal iliac bifurcation. The preferred construction will allow abifurcated or biluminal aortic graft system to be implanted prior to orfollowing the reconstruction of the iliac bifurcation, while maintainingblood flow to the internal iliac arteries.

SUMMARY OF THE INVENTION

[0007] In one aspect, this invention is a prosthetic graft for placementby a single delivery catheter at the bifurcation of a first vessel intosecond and third vessels within the vasculature of a patient comprisinga first graft conduit having first and second ends and first and secondstents, the first stent adapted to secure the first end of the firstgraft conduit within the lumen of the first vessel, the second stentadapted to secure the second end of the first graft conduit within thelumen of the second vessel; and a second graft conduit attached in fluidcommunication with the first graft conduit, the second graft conduithaving a third stent adapted to secure it within the lumen of the thirdvessel, the first and second graft conduits being sized and configuredto be contained within and delivered by the single delivery catheter.Preferably, the first graft conduit forms a first lumen which containsthe first and second stents and the second graft conduit forms a secondlumen which contains the third stent. The cross-sectional area of thefirst end of the first graft conduit may be greater than thecross-sectional area of the second end of the first graft conduit. Thefirst and second graft conduits preferably are configured to expand froma first delivery configuration to a second deployed configuration. Thecross-sectional area of the first end of the first graft conduitpreferably is at least as great as the cross-sectional area of theprosthetic graft at any localized point along a longitudinal axis of thefirst graft conduit when in the delivery configuration.

[0008] In a second aspect, this invention is a method for placing aprosthetic graft in a vessel of a patient's vascular system. Theprosthetic graft has a first tubular graft component and a secondtubular graft component in fluid communication with it. The methodcomprises providing a delivery catheter containing the prosthetic graftin a first delivery configuration, the catheter having an angularcontrol element for adjustably controlling the angle between the firstand second tubular graft components; advancing the catheter through thevessel to a desired location; manipulating the angular control elementto select a desired angle between the first and second tubular graftcomponents; and deploying the prosthetic graft in the vessel in a secondexpanded configuration. The angular control element of the catheter mayinclude a wire with a pre-formed angle and the step of manipulating theangular control element to select a desired angle may include advancingor retracting the wire. The first tubular graft component may include afirst stent attached thereto and the second tubular graft component mayinclude a second stent attached thereto. Preferably, the method furthercomprises securing the first and second tubular graft components withinthe vessel by radially expanding the first and second stents.

[0009] In a third aspect, this invention is a prosthetic graft forplacement by a single delivery catheter at the bifurcation of a firstvessel into second and third vessels within the vasculature of a patientcomprising a first graft conduit having first and second ends andincluding a tubular graft component defining a lumen and at least onestent located within the lumen and attached to the graft component, thestent adapted to secure the first end of the first graft conduit withinthe lumen of the first vessel and the second end of the first graftconduit within the lumen of the second vessel; and a second graftconduit attached in fluid communication with the first graft conduit,the second graft conduit including a tubular graft component defining alumen and a stent located within the lumen and attached to the graftcomponent and adapted to secure the second graft component within thelumen of the third vessel, the first and second graft conduits beingsized and configured to be contained within and delivered by the singledelivery catheter.

[0010] In a fourth aspect, this invention is a prosthetic graft forplacement by a single delivery catheter at the bifurcation of a firstvessel into second and third vessels within the vasculature of a patientcomprising: a first leg having first and second leg segments, the firstleg segment adapted to be deployed in the lumen of the first vessel, thesecond leg segment adapted to be deployed in the lumen of the secondvessel; and a second leg adapted to be deployed in the lumen of thethird vessel, whereby the first and second segments of the first leg andthe second leg are adapted to be independently deployable within thelumens of the first, second, and third vessels, the first and secondlegs being sized and configured to be contained within and delivered bythe single delivery catheter. The first leg may include a graftcomponent and at least one stent attached to the graft component and thesecond leg may include a graft component and a stent attached to thesecond leg graft component.

[0011] In a fifth aspect, this invention is a method of placing aprosthetic graft at the bifurcation of the common iliac artery into theexternal and internal iliac arteries, the prosthetic graft having afirst graft conduit with first and second ends and a second graftconduit attached in fluid communication with the first graft conduit,the method comprising: providing a delivery catheter containing theprosthetic graft in a first delivery configuration; introducing thedelivery catheter into a femoral artery on the same side as the commoniliac artery bifurcation; advancing the delivery catheter to the commoniliac artery bifurcation; and manipulating the delivery catheter todeploy the prosthetic graft in a second expanded configuration such thatthe first end of the first graft conduit is secured within the lumen ofthe common iliac artery, the second end of the first graft conduit issecured within the lumen of the external iliac artery and the secondgraft conduit is secured within the lumen of the internal iliac artery.The delivery catheter may include an angular control element foradjustably controlling the angle between the first and second graftconduits and the method may further include manipulating the angularcontrol element to select a desired angle between the first and secondgraft conduits. The first graft conduit may include a first stent andthe second graft conduit may include a second stent, the first andsecond stents adapted to expand from a first delivery configuration to asecond deployed configuration. The method may further include securingthe first end of the first graft conduit within the lumen of the commoniliac artery by expanding at least a portion of the first stent to itsdeployed configuration; the second end of the first graft conduit may besecured within the lumen of the external iliac artery by expanding atleast a portion of the first stent to its deployed configuration; andthe second graft conduit may be secured within the lumen of the internaliliac artery by expanding the second stent to its deployedconfiguration.

[0012] In a sixth aspect, this invention is a method for repairing anabdominal aneurysm in an aorta which branches into two iliac arteriesusing a graft system having a first leg which includes first and secondends and a first bifurcated prosthetic graft having a first tubulargraft component with first and second ends and a second tubular graftcomponent in fluid communication with the first tubular graft component.The method comprises: providing a delivery system including a firstguide wire; advancing the first guide wire through a first iliac arteryto a desired location in the aorta above the aneurysm; delivering thefirst leg over the first guide wire so that the first end of the firstleg is above the aneurysm on one side thereof and the second and is onthe other side of the aneurysm, the first leg extending across theaneurysm; delivering the first bifurcated prosthetic graft over thefirst guide wire so that the second tubular graft component ispositioned in the internal iliac artery, the first end of the firsttubular graft component is positioned in the common iliac artery and thesecond end of the first graft component is positioned in the externaliliac artery; and securing the second end of the first leg to the firstend of the first tubular graft component. The first leg may include anaortic stent attached to the first end of the first leg and an iliacstent attached to the second end of the first leg. The first prostheticgraft may include at least one stent attached to the first tubular graftcomponent and a stent attached to the second tubular graft component.The method may further comprise securing the first end of the first legin the aorta by deploying the aortic stent, securing the second end bydeploying the iliac stent and securing the first and second ends of thefirst tubular graft component by deploying the at least one stent andsecuring the second tubular graft component by securing the stentattached thereto. Preferably, the first leg is delivered over the firstguide wire prior to delivery of the first bifurcated prosthetic graftand the first bifurcated prosthetic graft is delivered over the firstguide wire prior to delivery of the first leg. This method may alsoinclude providing a first delivery catheter for delivering the first legand providing a second delivery catheter for delivering the firstbifurcated prosthetic graft. The graft system of this method may includea second leg which includes first and second ends and a secondbifurcated prosthetic graft having a first tubular graft component withfirst and second ends and a second tubular graft component in fluidcommunication with the first tubular graft component; the method thenfurther includes: providing a delivery system including a second guidewire; advancing the second guide wire through the second iliac artery toa desired location in the aorta above the aneurysm; delivering thesecond leg over the second guide wire so that the first end of thesecond leg is above the aneurysm and on one side thereof and the secondend of the second leg is on the other side of the aneurysm, the secondleg extending across the aneurysm; delivering the second bifurcatedprosthetic graft over the second guide wire so that the second tubulargraft component is positioned in the second internal iliac artery, thefirst end of the first tubular graft component is positioned in thesecond common iliac artery and the second graft component is positionedin the second external iliac artery; and securing the second end of thesecond leg to the first end of the first tubular graft component of thesecond prosthetic graft.

[0013] In a seventh aspect, this invention is a method for repairing anabdominal aneurysm using a graft system having a first leg whichincludes first and second ends and a first bifurcated prosthetic grafthaving a first tubular graft component with first and second ends and asecond tubular graft component in fluid communication with the firsttubular graft component, comprising: advancing the first leg through afirst iliac artery into the aorta so that the first end of the first legis above the aneurysm on one side thereof and the second end is on theother side of the aneurysm, the first leg extending across the aneurysm;after the first leg has been advanced, advancing the first bifurcatedprosthetic graft through the same iliac artery so that the secondtubular graft component is positioned in the internal iliac artery, thefirst end of the first tubular graft component is positioned in thecommon iliac artery and the second end of the first graft component ispositioned in the external iliac artery; and securing the second end ofthe first leg to the first end of the first tubular graft component. Thegraft system may include a second leg having first and second ends and asecond bifurcated prosthetic graft having a first tubular graftcomponent with first and second ends and a second tubular graftcomponent in fluid communication with the first tubular graft component.The method then further comprises: advancing the second leg through thesecond iliac artery into the aorta so that the first end of the secondleg is above the aneurysm on one side thereof and the second end of thesecond leg is on the other side of the aneurysm, the second legextending across the aneurysm; and after the second leg has beenadvanced, advancing the second bifurcated prosthetic graft through thesame iliac artery as the second leg so that the second tubular graftcomponent of the second bifurcated prosthetic graft is positioned in thesecond internal iliac artery, the first end of the first tubular graftcomponent is positioned in the second common iliac artery and the secondend of the first graft component is positioned in the second externaliliac artery; and securing the second end of the second leg to the firstend of the first tubular graft component of the second bifurcatedprosthetic graft.

[0014] In an eighth aspect, this invention is a graft system forrepairing an abdominal aneurysm comprising a first leg having first andsecond ends, the first end adapted to be secured in the aorta on oneside of the aneurysm and the second end adapted to be secured on theother side of the aneurysm; a first bifurcated prosthetic graft having afirst tubular graft component with first and second ends and a secondtubular graft component attached in fluid communication with the firsttubular graft component, the first end of the first tubular graftcomponent adapted to be secured in the common iliac artery, the secondend of the first tubular graft component adapted to be secured in theexternal iliac artery and the second tubular graft component adapted tobe secured in the internal iliac artery; a first guide wire sized to fitthrough a first iliac artery and through the aorta to a location abovethe aneurysm; a first delivery catheter configured to advance anddeliver the first leg across the first guide wire; and a second deliverycatheter configured to advance and deliver the first prosthetic graftacross the first guide wire. The graft system may include first leghaving an aortic stent attached to the first end and an iliac stentattached to the second end. The first bifurcated prosthetic graft mayhave at least one stent attached to the first tubular graft componentand a stent attached to the second tubular graft component. Preferably,the graft system includes: second leg having first and second ends, thefirst end adapted to be secured in the aorta on one side of the aneurysmand the second end adapted to be secured on the other side of theaneurysm; a second bifurcated prosthetic graft having a first tubulargraft component with first and second ends and a second tubular graftcomponent attached in fluid communication with the first tubular graftcomponent, the first end of the first tubular graft component adapted tobe secured in the common iliac artery, the second end of the firsttubular graft component adapted to be secured in the external iliacartery and the second tubular graft component adapted to be secured inthe internal iliac artery; a second guide wire sized to fit through thesecond iliac artery and through the aorta to a location above theaneurysm; a third delivery catheter configured to advance and deliverthe second leg across the second guide wire; and a fourth deliverycatheter configured to advance and deliver the second prosthetic graftacross the second guide wire.

BRIEF DESCRIPTION OF THE DRAWINGS

[0015]FIG. 1 is a diagrammatic view of a portion of a human vascularsystem depicting an abdominal aortic aneurysm extending from below therenal arteries and into the common iliac arteries and showingadvancement along a guide wire of a delivery catheter containing theprosthetic graft of the present invention.

[0016]FIG. 2 is a view of the aneurysm of FIG. 1 showing injection ofradiographic contrast solution at the internal iliac artery andprojection of the undeployed internal iliac leg of the prosthetic graftinto the internal iliac artery.

[0017]FIG. 3 is a view of the aneurysm of FIG. 1 showing deployment ofthe internal iliac leg of the prosthetic graft.

[0018]FIG. 4 is a view of the aneurysm of FIG. 1 showing deployment ofthe common/external iliac leg of the prosthetic graft.

[0019]FIG. 5 is a view of the aneurysm of FIG. 1 showing advancement ofthe control rod and advancement of the internal iliac sheath into thenose cone.

[0020]FIG. 6 is a view of the aneurysm of FIG. 1 after the deliverysystem has been removed.

[0021]FIG. 7 is a view of the aneurysm of FIG. 1 illustrating deploymentof a prosthetic graft in both iliac arteries.

[0022]FIG. 8 is a view similar to the aneurysm of FIG. 7 showing theprosthetic grafts combined with a biluminal endovascular graft system torepair the aneurysm.

[0023]FIG. 9 is a view of the delivery catheter assembly and prostheticgraft.

[0024]FIG. 10 is a view of the delivery catheter assembly illustratingthe lateral projection of the undeployed internal iliac leg andinjection of radiographic contrast solution.

[0025]FIG. 11 is a view of the delivery catheter assembly illustratingdeployment of the internal iliac leg of the prosthesis.

[0026]FIG. 12 is a view of the delivery catheter assembly illustratingexpansion of the common/external iliac leg of the prosthesis.

[0027]FIG. 13 is a view of the delivery catheter assembly showingmovement of the internal iliac sheath into the nose cone.

[0028]FIG. 14 is a plan view of the deployed prosthesis.

[0029]FIG. 15 is a cross-sectional view of the deployed prosthesis.

[0030] FIGS. 16-20 are cross-sectional views of a second embodiment ofthe prosthetic graft loaded into a delivery catheter during variousstages of the deployment process.

[0031]FIG. 21 is a cross-sectional view of the second embodiment of theprosthetic graft of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0032] The present invention is a prosthetic graft for use with a graftsystem used to repair the treatment of aortic aneurysms which extendinto at least one common iliac artery and do not have a suitable regionfor seating a stent or other attachment device. The graft is designed tobe used in combination with a graft system having legs extending intothe common iliac arteries and provides the graft system with a place tosecurely seat its iliac legs without blocking the internal iliac artery.

[0033] The terms “distal” and “proximal” as used herein refer only tothe delivery catheter of the prosthetic graft, not to the vasculature.The present method contemplates advancement of the delivery catheter ina retrograde manner (i.e., against the flow of blood). Therefore,“proximal” refers to a location closer to the physician and “distal”refers to a location farther from the physician. The vasculature isreferred to with respect to the cranial (closer to head) and caudal(closer to feet) directions. Also, as used in this specification, theterm “above”, in the context of relative positioning, with respect tothe aneurysm, refers to the regional cranial of the aneurysm, forexample, within the aorta, whereas “below” refers to the region of thevasculature caudal of the aneurysm, for example, within the common iliacarteries.

[0034] As best seen in FIGS. 14 and 15, the prosthesis includes acommon/external iliac leg 56 and an internal iliac leg 52. Each leg 56and 52 includes a graft component 57 and 53, and a stent component 59and 55, respectively. Both legs are generally tubular having a circularcross-section. The common/external iliac leg has an upper portion whichis positioned above the junction of the common iliac artery with theinternal iliac artery and the lower portion which is positioned in theexternal iliac artery below the internal iliac artery. The internaliliac leg is attached to and projects from the common/external iliac legand is positioned within the internal iliac artery. The attachmentbetween the graft and stent is preferably by sutures. The prosthesis isdelivered by way of a delivery catheter in a first contracted position.Once properly located the stent components expand radially duringdeployment so that the legs of the prosthetic graft are secured at theiliac bifurcation in their proper position.

[0035] The prosthesis is advanced into the iliac artery by means of acatheter. Typically, a guide catheter is introduced into the patient'svasculature via the femoral artery, through an incision made at alocation where the vessel is close to the undersurface of the skin. Aguide wire is snaked through the vasculature to a point above theaneurysm. The guide wire may be made of stainless steel or the like andis conventionally covered with an inert material (e.g.,polytetrafluoroethylene (PTFE)). The guide wire may remain in a fixedposition throughout the endoluminal bypass procedure. The catheter ofthis invention is then guided into the aneurysm along this guide wireand the prosthesis is deployed in the iliac artery.

[0036]FIG. 1 shows an aneurysm A in the infrarenal aorta and extendinginto the common iliac arteries. The infranrenal aorta is that portion ofthe aorta disposed between the left and right renal arteries RA and thecommon iliac arteries B which branch left and right. Each common iliacartery branches into internal and external iliac arteries D and C,respectively. External iliac artery C becomes the femoral artery belowthe inguinal ligament. Internal iliac artery D is also called thehypogastric artery. Delivery catheter 50 is shown advancing along guidewire 10 to the common iliac bifurcation site of the external andinternal iliac arteries C and D.

[0037]FIG. 9 is a cross-sectional view of the distal portion of deliverycatheter assembly 50 used to introduce and deploy the prosthetic graft.Inner shaft 20 runs the length of delivery catheter assembly 50. Innershaft 20 defines a central bore, or guide wire lumen, 22, which providesa means for inserting the catheter assembly into a patient along theguide wire (shown as 10 in FIGS. 1 to 7). Inner shaft 20 is fabricatedfrom a suitable polymer, such as HDPE, though other polymers as well asmetallic materials may be used. Lumen 22 allows catheter assembly 50 topass coaxially over a guide wire (such as a 0.035 inch diameterstainless steel guide wire typically used for endovascular procedures inthe aorta and iliac arteries).

[0038] About inner shaft 20 is mounted main body sheath 64 in slidableengagement with nose cone 60. Main body sheath 64 is fabricated from abiocompatible polymer such as PTFE or from polymer/metal composites.Composite materials may be particularly useful in adding strength andkink resistance to the main body sheath. The prosthetic graft 100 iscontained in the compartment formed between inner shaft 20, and thecombination of main body sheath 64 and nose cone 60. This compartmentalso provides a conduit from the proximal to the distal portion of thedelivery catheter for passage of cold saline and radiographic contrastsolution.

[0039] Nose cone 60 is fabricated from a flexible polymeric material orfrom metallic materials. Nose cone 60 provides a stiffness transitionbetween the relatively flexible guide wire and the stiffer main sheathbody 64. The distal tip of the delivery catheter is designed to be moreflexible at its distal-most portion and increasingly stiffer proximally.This arrangement will provide a strain-relieving effect, which aids inthe tractability of the device in tortuous artery bends.

[0040] As noted previously, prosthetic graft 100 includes internal iliacleg 52 and common/external iliac leg 56. Internal iliac leg 52preferably includes a graft material component 53 and a stent materialcomponent 55. Common/external iliac leg 56 preferably includes a graftmaterial component 57 and a stent material component 59. The graftmaterial component of each leg is connected to the stent materialcomponent, preferably by sutures.

[0041] The graft material components may be made of materials whichinclude woven and knitted materials comprising polyester,polytetrafluoroethylene (PTFE), silicones, and urethanes. The materialsmay be porous or non-porous and may be opaque to X-rays. Preferredmaterials include polyester fabric, for example, DACRON®, TEFLON®, orother suitable fabric. A preferred fabric for use in the graft componentis a 40 denier polyester yarn, having 180 to 250 end yarns per inch and80 to 120 pick yarns per inch. At this weave density, the graftcomponent is relatively impermeable to blood flow through the wall, butis relatively thin, ranging between 0.08 and 0.12 mm wall thickness.Preferably, the graft components are woven as tubes.

[0042] The stent material components are preferably self-expandable andare comprised of a shape memory alloy. Such an alloy can be deformedfrom an original, heat-stable configuration to a second, heat-unstableconfiguration. When in the second heat-unstable configuration theapplication of a desired temperature causes the alloy to revert to anoriginal heat-stable configuration. A particularly preferred shapememory alloy is binary nickel titanium comprising 55.8% Ni by weight.This NiTi alloy undergoes a phase transformation at physiologicaltemperatures. A stent made of this material is deformable when chilled.Thus, at low temperatures, (e.g., below 20° C.), the stent is compressedso it can be delivered to the desired location. The stent is kept at lowtemperatures by circulating chilled saline solution. The stent expandswhen the chilled saline is removed and it is exposed to highertemperatures, (e.g., 37° C.).

[0043] Preferably, the stent is fabricated from a single piece of alloytubing. The tubing is laser cut, shape-set by placing the tubing on amandrel, heat-set to its desired expanded shape and size andelectropolished. Electropolishing smoothes the surface of the alloy,which is believed to improve fatigue properties as well as extend thestrain-to-fracture and also improves thrombogenicity resistance.Preferably, the shape setting is performed at 550° C. for approximately20 minutes, followed by aging at 470° C. for 10 minutes. This heattreatment process provides for a stent that has a martensite toaustenite transformation temperature range of less than 15 Celsiusdegrees and an austenite finish temperature (A_(f)) of slightly lessthan 37° C.

[0044] The proximal portion of main body sheath 64 is connected to amanifold (not shown) which is connected to reservoirs holdingradiographic contrast solution and chilled saline. As best seen in FIG.10, chilled saline and/or radiographic contrast solution 70 flow throughmain body sheath 64 and out through orifices located at the tip of nosecone 60 and at the tip of internal iliac leg prosthesis 52.

[0045] Also within main body sheath 64 are sheath control rod 58 andstent retainer rod 66. The sheath control rod 58 extends from theproximal end to the distal portion of the catheter. The distal portionof the sheath control rod 58 is rigidly attached to sheath control rodslip ring 62. Sheath control rod slip ring 62 has a sliding fit withinner shaft 20. Sheath control rod slip ring 62 is also rigidly affixedto a shorter proximally facing iliac leg sheath control rod 63. Iliaccontrol rod 63 is positioned coaxially within the internal iliac leg 52of the prosthesis. Sheath control rod 63 is pre-formed to preferentiallyextend laterally from the axis of the main catheter when unrestrained bynose cone 60. In the completely unrestrained position sheath control rod63 causes internal iliac leg 56 to assume an angle of between about 45°and 90° with the longitudinal axis of the delivery catheter. Sheathcontrol rod 63 is rigidly attached to internal iliac sheath 61. Theretraction of sheath control rod 58 (in a proximal direction) slidesinternal iliac sheath 61 relative to internal iliac leg 52, thusexposing the internal iliac leg 52. When exposed to body temperature,the stent component of the internal iliac leg 52 expands.

[0046] Stent retainer rod 66 is connected to stent retaining slip rings68 located at the proximal and distal ends of common/external iliac leg56. Slip rings 68 surround the external/common iliac leg and preventaxial movement of the leg during advancement of the nose cone and innerlumen 20 during the retraction of sheath control rod 58 and/or theretraction of main body sheath 64. Stent retainer rod 66 is preferablymade of stainless steel. Preferably, slip rings 68 are made of platinumso they can provide radiopaque markings for angiographic visualizationof the prosthesis location. Slip rings 68 maintain a sliding fit withinner shaft 20, which allows relative movement between stent retainerrod 66 and inner shaft 20. The proximal portion of stent retainer rod 66is attached to a manifold (not shown) that provides the relativeanchoring and positioning of the assembly, main body sheath 64, andinner shaft 20.

[0047] Chilled saline flows through main body sheath 64, keeping thestent components of both legs cold. Expansion of the stent components 55and 59 of internal iliac leg 52 and external/common iliac leg 54 byexposing them to body temperature results in fully deploying prosthesis100.

[0048] Internal iliac leg sheath 61 is made from a polymer such as highdensity polyethylene (HDPE), though other polymers as well as metallicmaterials may be used. Sheath 61 surrounds internal iliac leg 52 andserves to navigate leg 52 into the internal iliac artery. Sheath 61preferably has a tapered segment at the distal end that provides anatraumatic surface for navigation into internal iliac artery B. The tipof sheath 61 may also have one or more orifices for the delivery ofradiographic contrast solution (such as depicted in FIGS. 3 and 10)and/or chilled saline. Although not shown, the delivery catheter may beprovided with separate lumens for the delivery of contrast solution andchilled saline.

[0049] FIGS. 9 to 13 show the steps of deploying prosthesis 100 whileFIGS. 1-8 show how those steps relate to the introduction, positioning,and deployment of the prosthetic graft to repair an abdominal aorticaneurysm in the vasculature of a human. FIG. 9 is a cross-section of thedelivery catheter assembly and prosthetic graft 100 in the fullyundeployed configuration which it would be in while the deliverycatheter is advanced to the branch of the common and internal iliacarteries as seen in FIG. 1. In FIG. 10, inner shaft 20 and nose cone 60have been advanced allowing the internal iliac leg 52 to deflectlaterally. Radiographic contrast solution 70 is flowing from an orificeat the tip of internal iliac leg 52. The angle of deflection can becontrolled by the relative position of nose cone 60 with regards to thesheath control rod 63. The more the nose cone 60 is advanced, thegreater the lateral angulation will be. The pre-form in the sheathcontrol rod 63 will determine the maximum unrestrained angle of theextended internal iliac leg 52 and sheath 61. Catheter assembly 50 canbe translated and rotated to position internal iliac leg 52 into theinternal iliac artery as seen in FIG. 2.

[0050] In FIG. 11, sheath control rod 5 8 has been retracted in aproximal direction. This movement advances internal iliac leg sheath 61off the distal end of internal iliac leg 52. The body temperature causesthe stent component 55 of internal iliac leg 52 to expand into the iliacartery as seen in FIG. 3.

[0051] In FIG. 12, main body sheath 64 has been retracted and nose cone60 further advanced, thus exposing the stent component 59 ofcommon/external iliac leg 54 to body temperature. The leg 54 thenexpands into the common iliac artery. The position of the prostheticgraft 100 is shown in FIG. 4.

[0052] In FIG. 13, sheath control rod 58 has been advanced distallyuntil the internal iliac leg sheath 61 is completely inside thecommon/external iliac leg. This is the position shown in FIG. 5. Oncesheath 61 is contained in the common/external iliac leg, the entirecatheter assembly can be withdrawn leaving only prosthesis 100 as seenin FIG. 6. Although a particular sequence of deploying the internaliliac leg and the upper (common iliac) and lower (external iliac)portions of the common/external iliac has been shown it will beappreciated that the delivery system allows deployment in any desiredsequence.

[0053]FIGS. 14 and 15 are plan and cross-sectional views of the fullydeployed prosthesis 100. The prosthesis is sized to fit within andsealingly engage the walls of the vessel at the common iliacbifurcation. Preferably, the diameter of the legs of the prostheticgraft are oversized so they are about 2 to 4 mm larger than the diameterof the vessel itself. The longitudinal length of the external/commoniliac leg is within the range of about 4 to 12 cm. The longitudinallength of the internal iliac leg is in the range of about 1 to 4 cm. Thediameter of the fully deployed external/common iliac leg is about 6 to18 mm while the diameter of the fully deployed internal iliac leg isabout 4 to 8 mm. FIG. 7 shows the prosthetic graft of the presentinvention deployed in both of the common iliac arteries. The procedurefor introducing, positioning, and deploying the second graft are thesame as those discussed above except that entry is through the femoralartery on the other side of the patient.

[0054]FIG. 8 shows the prosthetic grafts 100 of FIG. 7 connected to thelower or iliac portion of the legs of a biluminal endovascular graftsystem used to repair the aortic aneurysm. The prosthetic grafts of thepresent invention could be used in connection with any biluminal graftsystem which includes separate legs or conduits for each iliac artery.Such a system is disclosed in co-pending patent application entitled“Biluminal Endovascular Graft System”, filed Mar. 16, 1998 as Ser. No.09/039,776, the disclosure of which is incorporated herein by reference.An advantage of the present invention is that the prosthetic graft ofthe present invention can be delivered over the same guide wire as theindividual legs of the biluminal aortic graft system. A single guidewire introduced through the right femoral artery can be used fordelivery of one leg of the biluminal aortic stent and one bifurcatedprosthetic graft or a second guide wire introduced through the leftfemoral artery is used for delivery of the second leg of the biluminalaortic graft and the second prosthetic graft.

[0055] The biluminal aortic graft system could be deployed either beforeor after the prosthetic graft 100. If prosthetic grafts 100 are deployedfirst, then the iliac legs of the biluminal aortic graft system aredeployed into the upper portion of the common/external iliac legs of theprosthetic graft, with a minimum of a 2 cm overlap. This ensures properattachment and seating of the legs of the aortic graft without blockingthe internal iliac arteries. If the biluminal aortic graft is deployedbefore prosthetic grafts 100 then prosthetic grafts 100 would bedeployed into the iliac legs of the aortic graft, with a minimum of a 2cm overlap. In either case, the graft sizes will be selected to ensureproper attachment and seating of the grafts. The means of attachment ofthe grafts may include barbs or hooks on the stents of one or bothsystems (not shown) to ensure a secure attachment.

[0056]FIG. 21 is a cross-sectional view of a second embodiment of aprosthetic graft 200 in accordance with the present invention. FIGS.16-20 are cross-sectional views of the prosthetic graft 200 loaded intoa delivery catheter 150 during various stages of the deployment process.

[0057] As seen in FIG. 21, the prosthesis includes a common/externaliliac leg 156 and an internal iliac leg 152. Leg 156 includescommon/external artery graft component 157 and a common iliac arterystent component 159 a and an external iliac artery stent component 159b. Leg 152 includes a graft component 153 and a stent component 155. Thematerials which make-up the graft and stent components of prostheticgraft 200 are similar to those described with respect to those used inprosthetic graft 100.

[0058] By fabricating the common/external iliac leg 156 from separatestent components which are spaced apart from one another, the internaliliac leg 152 is allowed to be positioned closer to the longitudinalcenter line of the delivery catheter when collapsed. This configurationresults in a reduction in the diameter of the delivery system. The useof separate stents for the common iliac and external iliac arteries alsoallows flexibility in sizing at each end of the prosthetic graft.Preferably, the longitudinal length of the common/external iliac leg 156is about 8 to 12 cm. The longitudinal length of the internal iliac leg152 is about 1 to 4 cm. The diameter of the common iliac portion of thecommon/external iliac leg 156 is about 12 to 18 mm. The diameter of theexternal iliac portion of the common/external iliac leg 156 is about 6to 12 mm.

[0059]FIG. 16 is a cross-sectional view of the distal portion ofdelivery catheter assembly 150 used to introduce and deploy prostheticgraft 200. Inner shaft 120 runs the length of delivery catheter assembly150. Inner shaft 120 defines a central bore, or guide wire lumen 122which provides a means for inserting the catheter assembly into apatient along the guide wire. Guide wire lumen 122 allows catheterassembly 50 to pass coaxially over a guide wire.

[0060] About inner shaft 120 is mounted main body sheath 164 in slidableengagement with nose cone 160. Prosthetic graft 200 is contained in thecompartment formed between inner shaft 120, and the combination of mainbody sheath 164 and nose cone 160. This compartment also provides aconduit from the proximal to the distal portion of the delivery catheterfor passage of cold saline and radiographic contrast solution.

[0061] As in the previous embodiment, nose cone 160 provides a stiffnesstransition between the relatively flexible guide wire and the stiffermain body sheath 164.

[0062] The proximal portion of main body sheath 164 is connected to amanifold (not shown) which is connected to reservoirs holdingradiographic contrast solution and chilled saline. As in the previousembodiment, chilled saline and/or radiographic contrast solution 70flows through main body sheath 164 and out through orifices located atthe tip of nose cone 160 and at the tip of internal iliac leg prosthesis152.

[0063] Also located within main body sheath 164 are sheath control rod158 and stent retainer rod 166. The sheath control rod 158 extends fromthe proximal end to the distal portion of the catheter. The distalportion of the sheath control rod 158 is rigidly attached to sheathcontrol rod slip ring 162. Sheath control rod slip ring 162 has asliding fit with inner shaft 120. Sheath control rod slip ring is alsorigidly affixed to a shorter proximally facing iliac leg control rod163. Iliac control rod 163 is positioned coaxially within the internaliliac leg 152 of the prosthesis. Iliac control rod 163 is pre-formed topreferentially extend laterally from the axis of the main catheter whenunrestrained by nose cone 160. In the completely unrestrainedpositioned, iliac control rod 163 causes internal iliac leg 156 toassume an angle of between about 45° to 90° with the longitudinal axisof the delivery catheter. A filament sheath 180 is wrapped aroundinternal iliac leg 152. The filament sheath may be fabricated of PTFEsuture, however, other metallic and/or polymeric materials may be used.The filament is anchored to prosthetic graft 200 at a point 182 (FIG.18) and is wrapped around the stent component of the internal iliac legand attached to iliac control rod 163 at the proximal portion of theleg. The retraction of sheath control rod 158 (in a proximal direction)slides iliac control rod 163 out the end of iliac leg 152 causing theend of iliac control rod 163 to disengage with filament sheath 180, thusallowing the filament sheath to unwind. The wound filament sheathprovides a sealing conduit for the application of the chilled saline toleg 152. The filament may be a tightly wound thread or an overlappingribbon or any other configuration which results in the formation of asubstantially closed circuit. Once the filament is removed the body'stemperature allows the stent to expand.

[0064] Stent retainer rod 166 is connected to stent retainer slip rings168 located at the proximal and distal ends of stent components 159 aand 159 b. Slip rings 68 prevent axial movement of the leg duringadvancement of the nose cone and inner lumen 120 during the retractionof sheath control rod 158 and/or the retraction of main body sheath 164.Slip rings 168 maintain a sliding fit with inner shaft 120 which allowsrelative movement between stent retainer rod 166 and inner shaft 120.The proximal portion of stent retainer rod 166 is attached to a manifold(not shown) that provides the relative anchoring and positioning of theassembly, main body sheath 164, and inner shaft 120.

[0065] The introduction, positioning, and deployment of prosthetic graft200 is similar to that described with respect to prosthetic graft 100.FIG. 16 is a cross-section of the delivery catheter system andprosthetic graft 200 in the fully undeployed configuration it would havewhile the catheter is advanced to the branch of the common and internaliliac arteries. The position would be similar to that seen in FIG. 1.

[0066] In FIG. 17, inner shaft 120 and nose cone 160 have been advancedallowing the internal iliac leg 152 to deflect laterally. Radiographiccontrast solution 70 is flowing through internal iliac leg 152 and nosecone 160. The angle of deflection can be controlled by the relativeposition of nose cone 160 with regards to iliac control rod 163. Themore nose cone 160 is advanced, the greater the lateral angulation willbe. The pre-form in the internal iliac control rod 163 will determinethe maximum unrestrained angle of the extended internal iliac leg 152.Catheter assembly 150 can be translated and rotated to position theinternal iliac leg 152 into the internal iliac artery in a mannersimilar to that illustrated in FIG. 2. When internal iliac leg 152 hasbeen positioned into the internal iliac artery (FIG. 18), sheath controlrod 158 is retracted in the proximal direction as shown in FIG. 19. Thismovement dislodges iliac leg control rod 163 from filament sheath 180.Exposure of iliac leg stent component 155 to body temperature causes itto expand in the same position shown generally in FIG. 3.

[0067] In FIG. 20, the sheath control rod 158 is advanced in the distaldirection until the control rod 163 is completely inside nose cone 160.The main body sheath 164 has been retracted and nose cone 160 has beenfurther advanced, thus exposing stent components 159 a and 159 b ofcommon/external iliac leg 154 to body temperature. Leg 154 then expandsinto the common iliac artery such that the position of stent 159 a liesabove the junction with the internal iliac artery and stent 159 b liesbelow the junction with the internal iliac artery. The position ofprosthetic graft 200 is similar to that shown in FIG. 4. At this point,delivery catheter 150 is withdrawn through the lumen of common/externaliliac leg 156.

[0068] The prosthetic graft 200 can be used in the same manner as thatdescribed with respect to prosthetic graft 100.

What is claimed is:
 1. A prosthetic graft for placement by a singledelivery catheter at the bifurcation of a first vessel into second andthird vessels within the vasculature of a patient comprising: a firstgraft conduit having first and second ends and first and second stents,the first stent adapted to secure the first end of the first graftconduit within the lumen of the first vessel, the second stent adaptedto secure the second end of the first graft conduit within the lumen ofthe second vessel; and a second graft conduit attached in fluidcommunication with the first graft conduit, the second graft conduithaving a third stent adapted to secure it within the lumen of the thirdvessel, the first and second graft conduits being sized and configuredto be contained within and delivered by the single delivery catheter. 2.The prosthetic graft of claim 1 wherein the first graft conduit forms afirst lumen and the first and second stents are contained within thefirst lumen and wherein the second graft conduit forms a second lumenand wherein the third stent is within the second lumen.
 3. Theprosthetic graft of claim 1 wherein the cross-sectional area of thefirst end of the first graft conduit is greater than the cross-sectionalarea of the second end of the first graft conduit.
 4. The prostheticgraft of claim 1 wherein the first and second graft conduits areconfigured to expand from a first delivery configuration to a seconddeployed configuration and wherein the cross-sectional area of the firstend of the first graft conduit is at least as great as thecross-sectional area of the prosthetic graft at any localized pointalong a longitudinal axis of the first graft conduit when in thedelivery configuration.
 5. A method for placing a prosthetic graft in avessel of a patient's vascular system, the prosthetic graft having afirst tubular graft component and a second tubular graft component influid communication with the first tubular graft component, the methodcomprising: providing a delivery catheter containing the prostheticgraft in a first delivery configuration, the catheter having an angularcontrol element for adjustably controlling the angle between the firstand second tubular graft components; advancing the catheter through thevessel to a desired location; manipulating the angular control elementto select a desired angle between the first and second tubular graftcomponents; and deploying the prosthetic graft in the vessel in a secondexpanded configuration.
 6. The method of claim 5 wherein the angularcontrol element of the catheter includes a wire with a pre-formed angleand wherein the step of manipulating the angular control element toselect a desired angle includes advancing or retracting the wire.
 7. Themethod of claim 5 wherein the first tubular graft component includes afirst stent attached thereto and the second tubular graft componentincludes a second stent attached thereto, the method further comprisingsecuring the first and second tubular graft components within the vesselby radially expanding the first and second stents.
 8. A prosthetic graftfor placement by a single delivery catheter at the bifurcation of afirst vessel into second and third vessels within the vasculature of apatient comprising: a first graft conduit having first and second endsand including a tubular graft component defining a lumen and at leastone stent located within the lumen and attached to the graft component,the stent adapted to secure the first end of the first graft conduitwithin the lumen of the first vessel and the second end of the firstgraft conduit within the lumen of the second vessel; and a second graftconduit attached in fluid communication with the first graft conduit,the second graft conduit including a tubular graft component defining alumen and a stent located within the lumen and attached to the graftcomponent and adapted to secure the second graft component within thelumen of the third vessel, the first and second graft conduits beingsized and configured to be contained within and delivered by the singledelivery catheter.
 9. A prosthetic graft for placement by a singledelivery catheter at the bifurcation of a first vessel into second andthird vessels within the vasculature of a patient comprising: a firstleg having first and second leg segments, the first leg segment adaptedto be deployed in the lumen of the first vessel, the second leg segmentadapted to be deployed in the lumen of the second vessel; and a secondleg adapted to be deployed in the lumen of the third vessel, whereby thefirst and second segments of the first leg and the second leg areadapted to be independently deployable within the lumens of the first,second, and third vessels, the first and second legs being sized andconfigured to be contained within and delivered by the single deliverycatheter.
 10. The prosthetic graft of claim 9 wherein the first legincludes a graft component and at least one stent attached to the graftcomponent and wherein the second leg includes a graft component and astent attached to the second leg graft component.
 11. A method ofplacing a prosthetic graft at the bifurcation of the common iliac arteryinto the external and internal iliac arteries, the prosthetic grafthaving a first graft conduit with first and second ends and a secondgraft conduit attached in fluid communication with the first graftconduit, the method comprising: providing a delivery catheter containingthe prosthetic graft in a first delivery configuration; introducing thedelivery catheter into a femoral artery on the same side as the commoniliac artery bifurcation; advancing the delivery catheter to the commoniliac artery bifurcation; and manipulating the delivery catheter todeploy the prosthetic graft in a second expanded configuration such thatthe first end of the first graft conduit is secured within the lumen ofthe common iliac artery, the second end of the first graft conduit issecured within the lumen of the external iliac artery and the secondgraft conduit is secured within the lumen of the internal iliac artery.12. The method of claim 11 wherein the delivery catheter includes anangular control element for adjustably controlling the angle between thefirst and second graft conduits and wherein the method further includesmanipulating the angular control element to select a desired anglebetween the first and second graft conduits.
 13. The method of claim 11wherein the first graft conduit includes a first stent and the secondgraft conduit includes a second stent, the first and second stentsadapted to expand from a first delivery configuration to a seconddeployed configuration, the method further including securing the firstend of the first graft conduit within the lumen of the common iliacartery by expanding at least a portion of the first stent to itsdeployed configuration and wherein the second end of the first graftconduit is secured within the lumen of the external iliac artery byexpanding at least a portion of the first stent to its deployedconfiguration and wherein the second graft conduit is secured within thelumen of the internal iliac artery by expanding the second stent to itsdeployed configuration.
 14. A method for repairing an abdominal aneurysmin an aorta which branches into two iliac arteries using a graft systemhaving a first leg which includes first and second ends and a firstbifurcated prosthetic graft having a first tubular graft component withfirst and second ends and a second tubular graft component in fluidcommunication with the first tubular graft component, the methodcomprising: providing a delivery system including a first guide wire;advancing the first guide wire through a first iliac artery to a desiredlocation in the aorta above the aneurysm; delivering the first leg overthe first guide wire so that the first end of the first leg is above theaneurysm on one side thereof and the second and is on the other side ofthe aneurysm, the first leg extending across the aneurysm; deliveringthe first bifurcated prosthetic graft over the first guide wire so thatthe second tubular graft component is positioned in the internal iliacartery, the first end of the first tubular graft component is positionedin the common iliac artery and the second end of the first graftcomponent is positioned in the external iliac artery; and securing thesecond end of the first leg to the first end of the first tubular graftcomponent.
 15. The method of claim 14 wherein the first leg includes anaortic stent attached to the first end of the first leg and an iliacstent attached to the second end of the first leg and wherein the firstprosthetic graft includes at least one stent attached to the firsttubular graft component and a stent attached to the second tubular graftcomponent and wherein the method further comprises securing the firstend of the first leg in the aorta by deploying the aortic stent,securing the second end by deploying the iliac stent and securing thefirst and second ends of the first tubular graft component by deployingthe at least one stent and securing the second tubular graft componentby securing the stent attached thereto.
 16. The method of claim 14wherein the first leg is delivered over the first guide wire prior todelivery of the first bifurcated prosthetic graft.
 17. The method ofclaim 14 wherein the first bifurcated prosthetic graft is delivered overthe first guide wire prior to delivery of the first leg.
 18. The methodof claim 14 further including providing a first delivery catheter fordelivering the first leg and providing a second delivery catheter fordelivering the first bifurcated prosthetic graft.
 19. The method ofclaim 14 wherein the graft system includes a second leg which includesfirst and second ends and a second bifurcated prosthetic graft having afirst tubular graft component with first and second ends and a secondtubular graft component in fluid communication with the first tubulargraft component and wherein the method further includes: providing adelivery system including a second guide wire; advancing the secondguide wire through the second iliac artery to a desired location in theaorta above the aneurysm; delivering the second leg over the secondguide wire so that the first end of the second leg is above the aneurysmand on one side thereof and the second end of the second leg is on theother side of the aneurysm, the second leg extending across theaneurysm; delivering the second bifurcated prosthetic graft over thesecond guide wire so that the second tubular graft component ispositioned in the second internal iliac artery, the first end of thefirst tubular graft component is positioned in the second common iliacartery and the second graft component is positioned in the secondexternal iliac artery; and securing the second end of the second leg tothe first end of the first tubular graft component of the secondprosthetic graft.
 20. A method for repairing an abdominal aneurysm in anaorta which branches into two iliac arteries using a graft system havinga first leg which includes first and second ends and a first bifurcatedprosthetic graft having a first tubular graft component with first andsecond ends and a second tubular graft component in fluid communicationwith the first tubular graft component, the method comprising: advancingthe first leg through a first iliac artery into the aorta so that thefirst end of the first leg is above the aneurysm on one side thereof andthe second end is on the other side of the aneurysm, the first legextending across the aneurysm; after the first leg has been advanced,advancing the first bifurcated prosthetic graft through the same iliacartery so that the second tubular graft component is positioned in theinternal iliac artery, the first end of the first tubular graftcomponent is positioned in the common iliac artery and the second end ofthe first graft component is positioned in the external iliac artery;and securing the second end of the first leg to the first end of thefirst tubular graft component.
 21. The method of claim 21 wherein thegraft system includes a second leg having first and second ends and asecond bifurcated prosthetic graft having a first tubular graftcomponent with first and second ends and a second tubular graftcomponent in fluid communication with the first tubular graft component,the method further comprising: advancing the second leg through thesecond iliac artery into the aorta so that the first end of the secondleg is above the aneurysm on one side thereof and the second end of thesecond leg is on the other side of the aneurysm, the second legextending across the aneurysm; and after the second leg has beenadvanced, advancing the second bifurcated prosthetic graft through thesame iliac artery as the second leg so that the second tubular graftcomponent of the second bifurcated prosthetic graft is positioned in thesecond internal iliac artery, the first end of the first tubular graftcomponent is positioned in the second common iliac artery and the secondend of the first graft component is positioned in the second externaliliac artery; and securing the second end of the second leg to the firstend of the first tubular graft component of the second bifurcatedprosthetic graft.
 22. A graft system for repairing an abdominal aneurysmin an aorta which branches into two iliac arteries comprising: a firstleg having first and second ends, the first end adapted to be secured inthe aorta on one side of the aneurysm and the second end adapted to besecured on the other side of the aneurysm; a first bifurcated prostheticgraft having a first tubular graft component with first and second endsand a second tubular graft component attached in fluid communicationwith the first tubular graft component, the first end of the firsttubular graft component adapted to be secured in the common iliacartery, the second end of the first tubular graft component adapted tobe secured in the external iliac artery and the second tubular graftcomponent adapted to be secured in the internal iliac artery; a firstguide wire sized to fit through a first iliac artery and through theaorta to a location above the aneurysm; a first delivery catheterconfigured to advance and deliver the first leg across the first guidewire; and a second delivery catheter configured to advance and deliverthe first prosthetic graft across the first guide wire.
 23. The graftsystem of claim 22 wherein the first leg includes an aortic stentattached to the first end and an iliac stent attached to the second endand wherein the first bifurcated prosthetic graft has at least one stentattached to the first tubular graft component and a stent attached tothe second tubular graft component.
 24. The graft system of claim 22further including: a second leg having first and second ends, the firstend adapted to be secured in the aorta on one side of the aneurysm andthe second end adapted to be secured on the other side of the aneurysm;a second bifurcated prosthetic graft having a first tubular graftcomponent with first and second ends and a second tubular graftcomponent attached in fluid communication with the first tubular graftcomponent, the first end of the first tubular graft component adapted tobe secured in the common iliac artery, the second end of the firsttubular graft component adapted to be secured in the external iliacartery and the second tubular graft component adapted to be secured inthe internal iliac artery; a second guide wire sized to fit through thesecond iliac artery and through the aorta to a location above theaneurysm; a third delivery catheter configured to advance and deliverthe second leg across the second guide wire; and a fourth deliverycatheter configured to advance and deliver the second prosthetic graftacross the second guide wire.